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Lambda Legal and Transgender Legal Defense & Education Fund (TLDEF) represent several current and former state employees and their children who were denied coverage under the North Carolina State Health Plan (NCSHP) for medically necessary health care because they are transgender. Read more about the case, Kadel v. Folwell, here.

Max KadelPronouns: he/him

Max, 36, is a transgender man who lives in Carrboro, North Carolina. He works as an Administrative Support Associate at the UNC School of Government, where he was recognized with the 2018 “Star Heel Award” for his exemplary job performance. Max was denied medically necessary surgery in 2018 pursuant to the categorical exclusion of transition-related care in NCSHP. Max can’t afford to have surgery, and therefore must cope on a daily basis with the gender dysphoria this causes him. Max also is denied coverage for hormone therapy. Without this coverage, Max is forced to ration his testosterone past the expiration date because he has to pay for it out of pocket.

Michael Bunting (father)Pronouns: he/him

Shelley Bunting (mother)Pronouns: she/her

C.B. (son – not pictured)Pronouns: he/him

Michael Bunting, 52, lives in Chapel Hill, North Carolina with his wife, Shelley, and their 13-year-old son, C.B., who is transgender. Michael has been a UNC employee since 1990. Michael’s son, C.B. is in eighth grade. His favorite subjects in school are math and science and he likes swimming, parkour, and lacrosse. C.B. was assigned female at birth, but he has known he is male since he was very young, and in 2017, he told his parents that he is transgender. During the summer of 2017, when Michael’s NCSHP plan would cover C.B.’s care, he socially transitioned and doctors at Duke prescribed puberty-delaying medication. In 2018, when the transition-related care exclusion was reinstated, Michael and Shelley appealed to the NCSHP Board of Trustees because they were worried they could not pay for C.B.’s puberty-delaying medication out-of-pocket, but to no avail. The family had to purchase additional insurance with a high deductible in order to afford C.B.’s treatment. Michael is retiring from UNC in April after nearly 30 years of service, due in part to the discriminatory burden the exclusion places on his family.

Jason Fleck (father)Pronouns: he/him

Alexis Thonen (mother)Pronouns: she/her

Connor Thonen-Fleck (son)Pronouns: he/him

Jason Fleck, 43, is a Business Application Analyst at University of North Carolina Greensboro (UNCG). Jason and Alexis Thonen, also a UNCG employee, are parents of Connor Thonen-Fleck, 16, who is transgender. Connor was designated female at birth but has a male gender identity. Connor is a junior in high school. He also has a job at a veterinary clinic because he plans to pursue studies and a career in the veterinary field. Connor has struggled with gender dysphoria since he was young. While counseling, hormone therapy, and social transition have ameliorated his dysphoria, Connor still experiences significant distress due to the NCSHP’s denial of coverage for gender-confirming surgery that he needs, leaving the family with full financial burden for the cost of the care.

Julia McKeownPronouns: she/her

Julia, 43, is a transgender woman and has been an Assistant Professor in the Teacher Education and Learning Sciences Department of North Carolina State University College of Education since 2016. Julia also serves as the Graduate Coordinator for that program. Julia made the life-saving decision to live authentically as herself in 2010, and in 2013, Julia began the medical part of her transition and started hormone therapy. Despite being a North Carolina State employee enrolled in the NCSHP Plan, Julia was faced with the difficult decision of paying over $14,000 out of her savings and retirement accounts to pay for medically necessary services after coverage was denied under the plan. Julia currently resides in Apex, NC.

Sam SilvainePronouns: he/him, they/them

Sam Silvaine, 30, is transgender. He was employed at North Carolina State University, and enrolled in the NCSHP Plan from 2016-2018 while he completed a post-master’s counseling fellowship. In 2017, Sam’s NCSHP plan covered counseling and hormone therapy, but when the categorical exclusion of transition-related care was reinstated in NCSHP on January 1, 2018, the state health plan denied Sam’s request for medical care prescribed by his doctor. Sam had to pay for the surgery he needed out-of-pocket. Sam now lives in Syracuse, NY.